title: Epidural analgesia provides better pain management after live liver donation: a retrospective study.
abstract: Despite the increase in surgical volumes of live liver donation, there has been very little documentation of the postoperative pain experience. The primary aim of this study was to examine the difference in acute postoperative pain intensity and adverse effects between patients who received intravenous patient-controlled analgesia (IV PCA) or patient-controlled epidural analgesia (PCEA) for pain control after live liver donation surgery. A retrospective chart review was performed of 226 consecutive patients who underwent right living donor hepatic surgery at the Toronto General Hospital, Toronto, Canada. Patients who received as their primary postoperative analgesic modality IV PCA (n = 158) were compared to patients who received PCEA (n = 68). Demographic profiles for the 2 groups were similar with respect to age, sex, and body mass index at the time of surgery. For the first 3 postoperative days, pain intensity was significantly lower in patients who received epidural analgesia (P < 0.01). Clinically significant moderate pain (defined as a Numeric Rating Scale pain score >4) was reported more frequently in the IV PCA group (P < 0.05) along with increased sedation (P < 0.05). Pruritus was reported more frequently in the PCEA group of patients compared to the IV PCA group (P < 0.05). Significant between-group differences were not found for the incidence of postoperative vomiting, the time at which patients began fluid intake, the time to initial ambulation, or the length of hospital stay. In conclusion, epidural analgesia provides better postoperative pain relief, less sedation, but more pruritus than IV PCA after live liver donation.
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada. hance.clarke@uhn.on.ca
authors.forename: Hance
authors.initials: H
authors.lastname: Clarke
authors.forename: Tony
authors.initials: T
authors.lastname: Chandy
authors.forename: Coimbatore
authors.initials: C
authors.lastname: Srinivas
authors.forename: Salima
authors.initials: S
authors.lastname: Ladak
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Okubo
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitsakakis
authors.forename: Susan
authors.initials: S
authors.lastname: Holtzman
authors.forename: David
authors.initials: D
authors.lastname: Grant
authors.forename: Stuart A
authors.initials: SA
authors.lastname: McCluskey
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
mesh_terms: D000208:Acute Disease; D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006769:Hospitals, General; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage; D007902:Length of Stay; D008012:Lidocaine / Q000008:administration & dosage; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009864:Ontario; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine; D004091:Hydromorphone